Is robotic gait training effective for individuals with cerebral palsy? A systematic review and meta-analysis of randomized controlled trials

Aim: To determine if robotic gait training for individuals with cerebral palsy is more effective than the standard of care for improving function. Method: PubMed, Embase, Scopus, and Cochrane databases were searched from 1980–January, 2022 for articles that investigated robotic gait training versus standard of care (i.e. physical therapy or standard gait training) for individuals with cerebral palsy. Articles were included if a randomized controlled trial design was used, and excluded if robotic gait training was combined with another neuromuscular intervention, such as functional electrical stimulation. A meta-analysis of outcomes measured in at least four studies was conducted. Results: Eight citations met all criteria for full-text review and inclusion in the meta-analysis. A total of 188 individuals with cerebral palsy, ages four to 35, and Gross Motor Function Classification System levels I–IV were studied. Level of evidence ranged from 2b–1b. All studies utilized a tethered, assistive device for robotic gait training. The overall effect was not significantly different between the robotic gait training and control interventions for six minute walk test performance (95% CI: −0.17, 0.73; P = 0.22), free walking speed (95% CI: −0.18, 0.57; P = 0.30), or Gross Motor Function Measures D (Standing) (95% CI: −0.29, 0.39; P = 0.77) and E (Walking, Running and Jumping) (95% CI: −0.11, 0.57; P = 0.19). Conclusion: Tethered robotic devices that provide assistive gait training for individuals with cerebral palsy do not provide a greater benefit for improving mobility than the standard of care.